Healthcare Provider Details

I. General information

NPI: 1972728590
Provider Name (Legal Business Name): WAYNE GENERAL HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/17/2007
Last Update Date: 05/18/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

950 MATTHEW DR
WAYNESBORO MS
39367-2567
US

IV. Provider business mailing address

950 MATTHEW DR P O BOX 1249
WAYNESBORO MS
39367-2567
US

V. Phone/Fax

Practice location:
  • Phone: 601-735-5151
  • Fax: 601-735-7168
Mailing address:
  • Phone: 601-735-5151
  • Fax: 601-735-7168

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number11-288
License Number StateMS

VIII. Authorized Official

Name: MRS. KATHY WADDELL
Title or Position: ADMINISTRATOR
Credential:
Phone: 601-735-5151